Provider Demographics
NPI:1437299567
Name:MORRIS, MARILYN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 43RD AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3810
Mailing Address - Country:US
Mailing Address - Phone:970-330-8815
Mailing Address - Fax:970-330-0202
Practice Address - Street 1:2320 43RD AVENUE CT
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3810
Practice Address - Country:US
Practice Address - Phone:970-330-8815
Practice Address - Fax:970-330-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37757741Medicaid
CO500017362OtherRAILROAD MEDICARE
COC518028Medicare PIN
CO500017362OtherRAILROAD MEDICARE